BASE-LINE CHARACTERISTICS, NATURAL-HISTORY, AND RISK-FACTORS TO PROGRESSION IN EYES WITH STAGE-2 MACULAR HOLES - RESULTS FROM A PROSPECTIVERANDOMIZED CLINICAL-TRIAL

Purpose: The purpose of this study is (1) to determine baseline charac teristics and natural history of immature full-thickness macular holes , (2) to describe progression and resolution, and (3) to present new a spects of pathogenesis of idiopathic macular hole. Methods: The author s analyzed 41 eyes with stage 2 macular holes (37 patients) in a multi centered prospective randomized trial; 19 eyes were randomized to obse rvation (versus surgery) and had more than 12 months of follow-up, all owing determination of the natural course. Baseline and subsequent exa minations included best-refracted visual acuity (Early Treatment of Di abetic Retinopathy Study, potential acuity meter, Pelli-Robson contras t sensitivity, and Bailey-Lovie reading vision), of clinical examinati ons, photography, and fluorescein angiography. Result: Mean Snellen vi sual acuity was 20/66 at baseline. Centric holes usually had a small b reak (201 mu m average mean diameter) with a dark yellow ring and with out significant retinal elevation. Eccentric holes had a high maximum/ minimum diameter ratio (mean, 1.88 +/- 0.7) and an incomplete cuff of subretinal fluid or yellow ring. Posterior vitreous detachment prevale nce was 32% (8/25) in the centric hole group and 0% (0/16) in the ecce ntric hole group (P < 0.05). For the 19 eyes with 12 months of followu p, progression rate to stage 3 (or 4) was 74% (n = 14). The diameter o f the stage 2 holes increased significantly between baseline and 12 mo nths (P < 0.001). Progression rate to stage 3 was 100% (8/8) in the ey es with pericentral hyperfluorescence (PCH) and 55% (6/11) in eyes wit hout PCH (P < 0.05). Enlargement occurred in 100% of eccentric holes a nd 60% of centric holes (P = 0.09). Different progression patterns in eccentric and centric holes suggest different mechanisms of pathogenes is. Conclusion: Eccentric and centric stage 2 macular holes may have a different pathogenesis. Most stage 2 macular holes, especially with P CH (P < 0.05) or eccentric holes, progressed to stage 3 or 4. In addit ion to purely tangential traction, some component of obliquely oriente d anteroposterior vitreous traction component may be important for pat hogenesis of senile macular holes, particularly eccentric stage 2 macu lar holes.